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Application Form

Apply with TailG to get you own electric bicycles. Tell us what model, color, and payment terms and option you prefer so we can give you the best deal for your desired product. Kindly fill out the application form below and submit once done.

Choose a Model *

Selling Price

Terms

Down Payment

Monthly Installment

Application Information

Last Name *

First Name *

Middle Name *

Nick Name

Occupation

Gender *

Civil Status *

Address

Length of Stay *

Telephone Number

Mobile Number

Provincial Address

If Rented

Name of Landlord

Contact Number

Address

If Married

Last Name

First Name

Middle Initial

Nick Name

Contact Number

Telephone Number

Occupation

Address

If Employed

Company/Employer

Position

Length of Service

Address

If Self-Employed

Source of income

Business Address

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